Elsevier

The Journal of Nutrition

Volume 146, Issue 11, November 2016, Pages 2233-2243
The Journal of Nutrition

Flavanone Intake Is Inversely Associated with Risk of Incident Ischemic Stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study1234

https://doi.org/10.3945/jn.116.230185Get rights and content
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Abstract

Background: Flavonoids may have beneficial cerebrovascular effects, but evidence from racially and geographically representative cohorts in comprehensive flavonoid databases is lacking. Given racial and geographic disparities in stroke incidence, representative cohort studies are needed.

Objectives: We evaluated the association between flavonoid intake and incident ischemic stroke in a biracial, national cohort using updated flavonoid composition tables and assessed differences in flavonoid intake by sex, race, and region of residence.

Methods: We evaluated 20,024 participants in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a biracial prospective study. Participants with stroke history or missing dietary data were excluded. Flavonoid intake was estimated by using a Block98 food frequency questionnaire and the USDA’s Provisional Flavonoid Addendum and Proanthocyanidin Database. Associations between quintiles of flavonoid intake and incident ischemic stroke were evaluated by using Cox proportional hazards models, adjusting for confounders.

Results: Over 6.5 y, 524 acute ischemic strokes occurred. Flavanone intake was lower in the Southeastern United States but higher in blacks than in whites. After multivariable adjustment, flavanone intake was inversely associated with incident ischemic stroke (HR: 0.72; 95% CI: 0.55, 0.95; P-trend = 0.03). Consumption of citrus fruits and juices was inversely associated with incident ischemic stroke (HR: 0.69; 95% CI: 0.53, 0.91; P-trend = 0.02). Total flavonoids and other flavonoid subclasses were not associated with incident ischemic stroke. There was no statistical interaction with sex, race, or region for any flavonoid measure.

Conclusions: Greater consumption of flavanones, but not total or other flavonoid subclasses, was inversely associated with incident ischemic stroke. Associations did not differ by sex, race, or region for the association; however, regional differences in flavanone intake may contribute to regional disparities in ischemic stroke incidence. Higher flavanone intake in blacks suggests that flavanone intake is not implicated in racial disparities in ischemic stroke incidence.

Keywords

ischemic stroke
flavonoid
plant-based diet
polyphenol
epidemiology

Abbreviations

AIS
acute ischemic stroke
FNDDS
Food and Nutrient Database for Dietary Studies
REGARDS
REasons for Geographic and Racial Differences in Stroke

Cited by (0)

1

Supported by cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, NIH, Department of Health and Human Services. Additional funding was provided by grant F31 AG048719 from the National Institute of Aging and by grant K24 HL077506 from the National Heart, Lung, and Blood Institute.

2

Author disclosures: ME Goetz, SE Judd, TJ Hartman, W McClellan, A Anderson, and V Vaccarino, no conflicts of interest.

3

The content is solely the responsibility of the authors and does not necessarily represent the official views and positions of the National Institute of Neurological Disorders and Stroke; National Institute of Aging; National Heart, Lung, and Blood Institute; or NIH. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data.

4

Supplemental Tables 1–4 are available from the “Online Supporting Material” link in the online posting of the article and from the same link in the online table of contents at http://jn.nutrition.org.

Copyright © 2016 American Society of Nutrition. Published by Elsevier Inc. All rights reserved.